Best nursing homes 2013

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Finally, after ticking off the last item on a lengthy list of must-haves, you think you've found the best nursing home for your mom. The staff seems caring and professional. It's comfortable, homey, and Mom is OK with it. She might even come to like her new life.

But your work isn't over. You want to make sure Mom gets the care you were told she'd receive—and the care she deserves. "The resident's needs should be met by the facility, rather than having the patient meet the facility's needs," says Barbara Messinger-Rapport, director of the Cleveland Clinic's Center for Geriatric Medicine.

How do you make that happen?

What to ask

Start with your loved one. Isn't Dad going to be your best source of information on his own care? "Ask the questions you would want to be asked if the roles were reversed," says Cornelia Poer, a social worker in the Geriatric Evaluation and Treatment Clinic at Duke University Medical Center in Durham, N.C. Questions such as:

  • Are you comfortable?
  • Is anything worrying you?
  • Do you feel safe?
  • Do you feel respected?
  • If you need help and you push the call button, how long before somebody comes?
  • Have you gotten to know any of the other residents?
  • Do you like the staff—and any staff member in particular?

That last point may seem small, but whether your loved one clicks with a specific caregiver is important, says David A. Nace, chief of medical affairs for UPMC Senior Communities, a long-term care network in western Pennsylvania that is part of UPMC-University of Pittsburgh Medical Center. It shows he's making connections, growing in new social relationships. The trust that develops may also mean Dad takes his medication more reliably, or if behavioral issues stemming from dementia are a concern, it may be easier for one nurse than for another to manage them, says Nace.

Show interest and concern and identify major problems, but don't go overboard. "Inquiries are important, but try to avoid turning every visit into an interrogation," Poer says. "You will be able to determine if there are areas of concern in normal, everyday conversation."

Some questions will be better directed at staff members, particularly if your loved one has a cognition problem such as dementia or Alzheimer's disease. In the first days and weeks, the focus should be on the initial adjustment. Do Mom's nurses see any signs of depression? Does she appear to be making the transition smoothly? If not, what, specifically, is being done to help her?
Then drill down to her day-to-day routine:

  • When is she up?
  • Are her meals appropriately prepared—soft or pureed food if she has trouble chewing, low in fat and salt if she has a heart condition?
  • Is she taking her medications when and as often as she should? (The timing of each medication should be documented.) If there's been a consistent problem, how is that being addressed?
  • Is there a reason to change any of her medications?
  • Is she exercising or participating in other physical activities?
  • Is she social?

"I like to see if the patients are usually in their rooms," says Susan Leonard, a geriatrician at Ronald Reagan UCLA Medical Center. "Not being in their rooms means they are participating in activities, dining, or in the hallway socializing with others, which may suggest a better social environment for residents." But you'll want to see for yourself whether empty rooms might only mean residents are parked on sofas and in wheelchairs elsewhere in front of TVs.

Don't be afraid to broach more sensitive topics. If you were recently alerted of a behavioral issue or medical emergency, talk to both Mom and the staff to figure out whether it was handled properly. You want to know what the staff did and what changes in care they've made.

It's helpful to have a main point of contact during the day's various shifts. You should feel like you can call at any time, but Nace observes that it's good to know up front what the best times are for getting general updates. And don't settle for less than you need to know. If you don't get an answer, head up the chain of command to a unit supervisor, assistant director, or director.